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Medicina
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Management of Septic Shock in ICU
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Management of Septic Shock in ICU

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Intensive Care/ Anesthesiology".

Deadline for manuscript submissions: 20 November 2024 | Viewed by 2980

Special Issue Editor

Dr. Nicoleta Alice Dragoescu

E-Mail Website
Guest Editor
Department of Anesthesiology and Intensive Care, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
Interests: sepsis; septic shock; prognosis; presepsin; neutrophil to lymphocyte ratio (NLR); agenesis of ductus venosus; portal venous system anomalies

Special Issue Information

Dear Colleagues,

This Special Issue of Medicina, entitled "Management of Septic Shock in ICU", aims to provide a comprehensive exploration of the contemporary approaches adopted to address one of the most critical challenges in intensive care. Focused on optimizing patient outcomes, this Issue synthesizes cutting-edge research and clinical insights into a cohesive narrative. Emphasizing early detection, we aim to publish research underscoring the importance of using advanced monitoring techniques for the timely identification of septic shock.

Two central themes of this publication will include antibiotic stewardship and the judicious use of antimicrobials in the face of rising antimicrobial resistance. This Issue will delve into evolving fluid resuscitation strategies and the integration of emerging technologies, showcasing the dynamic nature of septic shock management. Multidisciplinary collaboration will take center stage, reflecting the fact that effective care necessitates a unified effort across diverse healthcare domains.

If successful, this Special Issue will serve as a beacon for healthcare professionals seeking to refine their protocols by offering a nuanced understanding of personalized treatment approaches. By encapsulating key elements such as early diagnosis, antibiotic stewardship, fluid resuscitation, technological integration, and interdisciplinary collaboration, this Issue offers to equip practitioners with a holistic perspective on managing septic shock in an ICU setting. Ultimately, this constitutes a vital resource, contributing to ongoing advancements in critical care medicine.

Authors are welcome to submit research papers, short reports, reviews, systematic reviews, meta-analyses, letters to the editor, and commentary papers.

Dr. Nicoleta Alice Dragoescu
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • septic shock
  • definition
  • diagnostic
  • management
  • bundles
  • intensive care unit

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Further information on MDPI's Special Issue polices can be found here.

Published Papers (3 papers)

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Research

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16 pages, 2665 KiB  
Article
The Role of Programmed Cell Death 1/Programmed Death Ligand 1 (PD-1/PD-L1) Axis in Sepsis-Induced Apoptosis
by Oana Coman, Bianca-Liana Grigorescu, Adina Huțanu, Anca Bacârea, Anca Meda Văsieșiu, Raluca Ștefania Fodor, Florin Stoica and Leonard Azamfirei
Medicina 2024, 60(7), 1174; https://doi.org/10.3390/medicina60071174 - 19 Jul 2024
Viewed by 625
Abstract
Background and Objectives: Sepsis involves a dysregulated host response, characterized by simultaneous immunosuppression and hyperinflammation. Initially, there is the release of pro-inflammatory factors and immune system dysfunction, followed by persistent immune paralysis leading to apoptosis. This study investigates sepsis-induced apoptosis and its [...] Read more.
Background and Objectives: Sepsis involves a dysregulated host response, characterized by simultaneous immunosuppression and hyperinflammation. Initially, there is the release of pro-inflammatory factors and immune system dysfunction, followed by persistent immune paralysis leading to apoptosis. This study investigates sepsis-induced apoptosis and its pathways, by assessing changes in PD-1 and PD-L1 serum levels, CD4+ and CD8+ T cells, and Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE II) severity scores. Materials and Methods: This prospective, observational, single-centre study enrolled 87 sepsis patients admitted to the intensive care unit at the County Emergency Clinical Hospital in Târgu Mureș, Romania. We monitored the parameters on day 1 (the day sepsis or septic shock was diagnosed as per the Sepsis-3 Consensus) and day 5. Results: Our study found a statistically significant variation in the SOFA score for the entirety of the patients between the studied days (p = 0.001), as well as for the studied patient groups: sepsis, septic shock, survivors, and non-survivors (p = 0.001, p = 0.003, p = 0.01, p = 0.03). On day 1, we found statistically significant correlations between CD8+ cells and PD-1 (p = 0.02) and PD-L1 (p = 0.04), CD4+ and CD8+ cells (p < 0.0001), SOFA and APACHE II scores (p < 0.0001), and SOFA and APACHE II scores and PD-L1 (p = 0.001 and p = 0.01). On day 5, we found statistically significant correlations between CD4+ and CD8+ cells and PD-L1 (p = 0.03 and p = 0.0099), CD4+ and CD8+ cells (p < 0.0001), and SOFA and APACHE II scores (p < 0.0001). Conclusions: The reduction in Th CD4+ and Tc CD8+ lymphocyte subpopulations were evident from day 1, indicating that apoptosis is a crucial factor in the progression of sepsis and septic shock. The increased expression of the PD-1/PD-L1 axis impairs costimulatory signalling, leading to diminished T cell responses and lymphopenia, thereby increasing the susceptibility to nosocomial infections. Full article
(This article belongs to the Special Issue Management of Septic Shock in ICU)
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13 pages, 752 KiB  
Article
Risk Assessment of Venous Thromboembolism among Septic Shock Patients: Single versus Concurrent Insertion of Central Venous Catheters
by Cosmin Iosif Trebuian, Adina Maria Marza, Alexandru Cristian Cindrea, Alina Petrica, Stefania Onea, Dumitru Sutoi, Claudiu Barsac, Iulia Crintea-Najette, Daian Popa, Raul Chioibas and Ovidiu Alexandru Mederle
Medicina 2024, 60(5), 785; https://doi.org/10.3390/medicina60050785 - 9 May 2024
Cited by 1 | Viewed by 1049
Abstract
Background and Objectives: Thrombosis is a serious complication experienced by some hospitalized patients. While concurrent placement of two catheters (CVCs) in the same central vein offers several benefits in clinical settings, we aimed to investigate the role of this procedure in relation to [...] Read more.
Background and Objectives: Thrombosis is a serious complication experienced by some hospitalized patients. While concurrent placement of two catheters (CVCs) in the same central vein offers several benefits in clinical settings, we aimed to investigate the role of this procedure in relation to the risk of thrombosis. Materials and Methods: Over a two-year retrospective analysis, we examined 114 patients with septic shock caused by a pulmonary infection, who underwent the insertion of one or more central lines into a central vein during their ICU stay. Logistic regression models were employed to assess the correlation between the Caprini risk score, the placement of two CVCs in the same vein, COVID-19 infection and the risk of venous thromboembolism (VTE). Results: In total, 53% of the patients underwent the concurrent insertion of two CVCs. The placement of two CVCs in the same vein appears to elevate the VTE risk by 2.5 times (95% CI: 1.03–6.12). Logistic regression analysis indicated that hemodialysis catheters amplify the VTE risk by nearly five times, even when accounting for a series of factors (95% CI: 1.86–12.31). Conclusions: Our study suggests that the elevated risk of VTE is likely associated with the insertion of the hemodialysis catheters rather than solely the presence of two concurrent catheters. Full article
(This article belongs to the Special Issue Management of Septic Shock in ICU)
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Review

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10 pages, 722 KiB  
Review
Angiotensin II—Real-Life Use and Literature Review
by Andreja Möller Petrun and Andrej Markota
Medicina 2024, 60(9), 1483; https://doi.org/10.3390/medicina60091483 - 11 Sep 2024
Viewed by 247
Abstract
Angiotensin II is a recently introduced vasopressor, which has been available since 2017. The novelty and the relatively high cost of angiotensin II currently limit its broader application. It induces vasoconstriction by activating the renin–angiotensin–aldosterone system and is currently the sole vasopressor functioning [...] Read more.
Angiotensin II is a recently introduced vasopressor, which has been available since 2017. The novelty and the relatively high cost of angiotensin II currently limit its broader application. It induces vasoconstriction by activating the renin–angiotensin–aldosterone system and is currently the sole vasopressor functioning through this pathway. Beyond vasoconstriction, angiotensin II also affects various other physiological processes. Current evidence supports its use in managing vasoplegic and cardiogenic shock in patients who are unresponsive to catecholamines and vasopressin. However, due to limited data, the optimal timing for initiating therapy with angiotensin II, strategies for combining it with other vasopressors, and strategies for its discontinuation remain unclear. Ongoing and planned studies aim to address some of these uncertainties. This article reviews the physiological and pathophysiological effects of angiotensin II, describes its pharmacology, and provides a narrative review of the current literature. Full article
(This article belongs to the Special Issue Management of Septic Shock in ICU)
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